At enrollment deadline, affordability may be real test of Affordable Care Act

March 31, 2014 at 6:28 PM EST

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The crush of last-minute signups for health insurance at HealthCare.gov drove the website out of service for part of the day. Some applicants turned to in-person help centers around the country to enroll. Health policy analyst Susan Dentzer and Mary Agnes Carey of Kaiser Health News join Judy Woodruff to discuss what’s at stake for the Affordable Care Act.

JUDY WOODRUFF: It’s the last day for Americans to sign up for the new health insurance exchanges in this first year of the program, and there was plenty of demand. There were also more glitches and problems.

But, in stark contrast to the launch last fall, hundreds of thousands have been able to sign up in recent days. And the system seemed more resilient than in October.

The HealthCare.gov website bent under a last minute crush of traffic, more than 125,000 users at any given moment. The site was out of service for nearly four hours this morning, and it briefly went down again in the afternoon.

WOMAN: I can’t believe this is actually working.

WOMAN: Yes, it works very well.

JUDY WOODRUFF: Some last-minute applicants sought out help centers around the country. This woman signed up for coverage in Arlington, Virginia.

SARA SHALVA, Insurance Applicant: It’s going to save us thousands of dollars, thousands of dollars a year, in terms of what — our prescription — his prescription is going to be covered. We’re going to — our monthly payment is considerably less. We’re getting better coverage.

JUDY WOODRUFF: Others were frustrated. One Texas woman said she gave up trying to enroll online.

ANGELA JOHNSON, Insurance Applicant: It was just a mess on there, like page after page, and it never got me to where I needed to be, so I was like, I’m giving up on this, and I’m just going to go here.

JUDY WOODRUFF: As the day began, more than six million people had signed up through the federal and state-run exchanges. That’s about a million shy of the original goal. Estimates from some insurers show 80 percent of those applicants had paid their premiums. In addition, more than four million people will be eligible coverage through Medicaid.

At the White House today, Press Secretary Jay Carney painted a picture of success.

JAY CARNEY, White House Press Secretary: We’re achieving something today that I know has our critics gnashing their teeth. I know it leaves them with the need to go back to the drawing board when it comes to other means of trying to attack a law that is providing opportunity and security to millions of Americans.

JUDY WOODRUFF: But Senator Lindsey Graham and other Republicans insisted again the health care law is unworkable. He tweeted: “You have to tear it down and start over.”

In the meantime, enrollments aren’t done just yet. The administration is granting extensions to anyone who says personal issues or technical problems prevented their completing the process.

And we look at some of the many questions being asked today.

We’re joined again by Mary Agnes Carey of Kaiser Health News and Susan Dentzer, a health analyst for the NewsHour.

Welcome to the program.

MARY AGNES CAREY, Kaiser Health News: Great to be here.

SUSAN DENTZER, Health Policy Analyst: Thank you, Judy.

JUDY WOODRUFF: So, Susan, what’s the very latest on what’s happened today? We know people were madly signing up. At least some were madly signing up. What were the final numbers?

SUSAN DENTZER: Well, we don’t know the actual final numbers for today, but we do know that the Department of Health and Human Services says that 1.6 million visitors — visits were made to HealthCare.gov, the federal health insurance Web site, and that more than 800,000 calls were placed to call centers.

And that, of course, leaves out what happened in the state exchanges. And we know there are 14 state-based exchanges and of course the exchange in the District of Columbia. We don’t know the numbers were there, but it’s quite conceivable that potentially another million people have signed up in the past few days.

JUDY WOODRUFF: For anybody who’s watching who hasn’t signed up, who wants to sign up, how much time do they have? What’s the penalty if they don’t?

SUSAN DENTZER: Well, right now, you can go on the Web site if you’re enroll through the federal exchange and check a box saying that you want to get on. You will get an e-mail potentially later today. We already know the administration has said if you have had difficulty enrolling to date, you have at least until the middle of April to enroll.

And then we have these special enrollment periods that — where people with various other circumstances will be able to enroll, and there’s no outside deadline that has been set on that yet. So it could be we will be getting more enrollment for the next several months. The other important thing to point out is that anybody who wants to sign up for Medicaid who’s eligible can sign up at any point, so Medicaid enrollment will continue throughout the year.

JUDY WOODRUFF: No deadline on that.

Mary Agnes Carey, the whole purpose of this in the beginning, or at least a large part of the purpose, was to get people who didn’t have health insurance to get covered. How — in terms of the big picture, how is that going?

MARY AGNES CAREY: Well, it’s going fairly well from the administration’s point of view. The deadline — the goal, rather, of six million was hit last week. They’re hoping they can get more folks enrolled.

But I think a key test is the affordability question. Do people find the premiums affordable? How about their co-pays, their out-of-pocket expenses, that sort of thing, the deductibles? That seems to be the real test that we have to keep looking at to see if it works.

JUDY WOODRUFF: And what are you finding about that? What are you hearing? I know you have been reporting on this for months now. Are you finding — is the preponderance of evidence that people are saying, this is not as bad as I thought, it isn’t as expensive, or what are you hearing?

MARY AGNES CAREY: It’s kind of all over the map.

It really varies depending on where you live. How competitive is the marketplace where you live? How many insurers want to get involved? What are the prices at the local hospitals and physicians are charging? How does that impact the negotiations? And there’s variance.

For example, our reporters found out, in Philadelphia, you might pay 77 percent more for a policy if you’re a 40-year-old man than if you got that same policy in Pittsburgh. Now, the subsidies can help with that cost. But, in Georgia, for example, prices can double in one part of the state vs. another.

We found a rural Georgia town where the premiums were actually more expensive than Beverly Hills, which is not what you would think.

JUDY WOODRUFF: So, Susan, is it hit or miss all over the country?

SUSAN DENTZER: Well, this is a complicated law laid on top on what was already a very complicated insurance system.

JUDY WOODRUFF: And I mean in terms of the affordability of it. Right. Right.

SUSAN DENTZER: Well, other ways to look at it are as follows.

We know that 80 percent of the people who have signed up on the marketplaces so far have been eligible for the premium tax credits. And for some people, that lowers the cost to zero. They pay zero premium to get coverage. So, we will have to see how all of this comes together when the final numbers are in.

JUDY WOODRUFF: And that’s not Medicaid. That’s people who have coverage.

SUSAN DENTZER: That’s people who have private coverage now through the exchanges, but are paying a zero premium, basically nothing, because they have substantial premium tax credits.

JUDY WOODRUFF: We know, Mary Agnes, there’s been relentless criticism from Republicans. We’re hearing it again today. They either want to repeal it, or fix it, change it dramatically.

What are you finding from ordinary folks? And what are you — I’m interested in hearing from both of you what about the actual players, the health care providers, not just the insurance companies, but hospitals, doctors and others? How are they feeling about it at this point?

MARY AGNES CAREY: People seem to like individual elements of the health law.

For example, the polling has shown if you talk about no more annual limits, no more lifetime limits, people like that idea, keeping their adult child up to age 26 on their health insurance plan. But again the problem comes in looking at the affordability. It’s really going to be a local story. We talk about this at the national level, and that makes sense, but it really will depend on what is the risk pool, what are the premiums set up at the local and state levels as people look at this going forward?

JUDY WOODRUFF: How do you see it, Susan?

SUSAN DENTZER: Well, it’s variable again.

The anecdotal evidence from some insurers are that they’re feeling pretty good about the risk pool, that lots of younger people have signed up. It won’t be true nationally. We will see other insurers with different experiences in different parts of the country. Same thing with health care providers. If you’re in an area where there isn’t a lot of access to, say, good primary care, some of the community health centers are feeling very much under the gun and overrun, because so many people now are getting coverage and presenting with illnesses that they have had for a long time and haven’t gotten care for, for a long time.

JUDY WOODRUFF: And so in terms of the reaction of hospitals, doctors, nurses, it’s really — it depends on where you are and what the structure — the health care structure is.

SUSAN DENTZER: Very much so. It’s a patchwork around the country.

JUDY WOODRUFF: You both have been covering this nonstop since last October, and really even before. This today is an important milestone, Mary Agnes. What would you say the next measuring milestone is? What do we look? What do you look for next here?

MARY AGNES CAREY: If people think it’s good for them. Do they find, again, the coverage affordable? Can they get access to the providers they wanted?

Some of these policies have fairly high co-pays, out-of-pocket costs, deductibles and so on. How does that play out? We have talked about how many people have paid their premium. The insurance industry is saying that’s about at the 80 percent mark, which is the industry standard, but as this goes on, does someone — do people sign up for a premium and they decide, gosh, they just can’t cut it? Maybe the subsidies don’t help them enough. Maybe they do.

I think it is really going to take a while to see this play out, to see if it works for people, if they think it’s a good deal or not.

SUSAN DENTZER: And we will be looking at the next open enrollment period, November 15 through February 15 of next year, to see what the insurance premiums are in year two.

Are the insurance premiums going to go up substantially? Are they going to be about the same? A long way between now and when we will know the answer to that.

JUDY WOODRUFF: Well, I don’t think anybody is watching more closely than the two of you.

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